AMERICAN YOUTH FOOTBALL Participant Forms

REQUIRED FOR REGIONAL AND NATIONAL PARTICIPATION

Participant forms must be presented to the Coach or Team Administrator for inclusion in the team book. Team books must be presented for compliance verification prior to participation in any American Youth Football, Inc., American Youth Cheer dba, Regional, National sanctioned event.

All rostered Participants must complete the following paperwork in order to be allowed to participate in any American Youth Football, Inc., American Youth Cheer dba, Regional, National sanctioned event.

Image Release - MINOR

Waiver and Release of Liability - MINOR

Emergency Medical Treatment, Consent and Information Form

Proof of AGE - (see association official for acceptable document

NOTE: - All-American Division (grade based) Required Documentation

Report Card - Please HIGHLIGHT Division / Grade attending

All rostered Participants must receive Medical Clearance in order to be allowed to participate in any American Youth Football, Inc., American Youth Cheer dba, Regional, National sanctioned event. Please use the following form if you have not already supplied an acceptable medical clearance to your team.

Medical Clearance Form

Participant Medical Clearance will become void in the event of an Injury, Accident, or Illness attended to by a licensed medical professional. The Resume Participation Medical Clearance must be signed by the attending medical professional in order for the participant to resume active participation. The signed form must be presented to the American Youth Football, Inc., American Youth Cheer dba, Regional, National event official.

Resume Participation Medical Clearance Form

Some form of Participant Photo Identification system must be employed by your Association. If none was used the following forms can substituted, and is preferred for the American Youth Football, Inc., American Youth Cheer dba, Regional, National sanctioned events.

Official Participation Tracking and ID Card

Any form / document used for your local Association / Conference must be reviewed by your local council to insure it's compliance with all of your state and local statutes. AYF makes no representation or warrantee that any of these conditions have been met. AMERICAN YOUTH FOOTBALL Participation, Tracking and ID Card - All-American Division ASSOCIATION NAME - ______

A ASSOCIATION NAME S S PLACE PHOTO / DMV / MILITARY ID O DIVISION OF PLAY - TEAM NAME CARD HERE C I PARTICIPANT NAME A T JERSEY # Grade AGE ( /31) I 7 O N PARTICIPANT PARENT/GUARDIAN NAME

HOME PHONE WORK PHONE CELL PHONE

I, Hereby, With My Signature, Do Certify That The Information Below Has Been Collected And Verified By The Means, As A Minimum, As Instructed In The AYF National Rulebook And/Or Operations Manuel, Current Version.

OFFICIAL PLAYER CERTIFICATION Conference Verification Signature/STAMP Association Verification Signature/STAMP LEAGUE USE ONLY

DATE OF BIRTH: Age As of GRADE / AGE PARTICIPANT MEDICAL WAIVER/ EMERGENCY SCHOLASTICS CERTIFICATION CONTRACT CLEARANCE RELEASE MEDICAL / 7 / 31 CONSENT

Month / Day / Year

GAME DATE PLAYER CHECK CODE GAME DATE PLAYER CHECK CODE

R JAMBOREE Week 11 P E Week 1 Week 12 O G S U Week 2 Week 13 T L A Week 3 Week 14 S R Week 4 Week 15 E A S Week 5 Week 16 S E O A Week 6 Week 17 N S O Week 7 Week 18 N Week 8 Week 19

Week 9 Week 20

Week 10 Week 21

INSTRUCTIONS: PLAYER CHECK Will Enter Date, Verify The Identity, Of Each Participant, Initial Each Participant Card, CODE: OK = Everything Verified, I = Sick/Injured, A = Absent / Dropped ALL MUST BE CHECKED IN / VERIFIED PLAYING OR NOT / ENTER DETAIL UNDER CODE Page 1 of 2 Participation Contract, Tracking and ID Card - Page 2

Last Name First Name Initial Preferred (nick) Name

Street Address City / Town State Zip Code Home Phone

Date Of Birth (M/D/YR) Age as of 12/31 Parent/Guardian First Name Parent/Guardian Last Name

Grade in Fall School in Fall School Phone Home Email Address

Medical Insurance (circle one) Name Of Insurance Carrier Policy # YES / NO

Football: Cheer: --CHECK ONE -- Registration Fee: $ Check# Cash:

GRAY AREAS FOR OFFICIAL USE ONLY !! Association: Division: Team:

Jersey Number Assigned: Equipment / Uniform Issued Returned

PERMISSION TO PARTICIPATE I acknowledge that I am fully aware of the potential dangers of participation in any sport and I fully understand that participation in football, cheerleading, dance and/or step may result in SERIOUS INJURIES, PARALYSIS, PERMANANET DISABILITY AND/OR DEATH. Furthermore, I fully acknowledge and understand that protective equipment does not prevent all participant injuries. I, the parent/guardian of the above-named participant, do hereby give my approval for my child/ward to participate, and further assert that I have verified with my child/wards physician, and in my opinion, my child/ward is physically fit and can participate without limitation in any and all Local, Regional, National, League/Conference, Association and team/squad activities, including transportation to and from the activities by a licensed driver. SCHOLASTIC FITNESS Initial: ______I am of the opinion that my son/daughter/ward is scholastically fit and would benefit by participation in this program. I agree to submit a copy of my son/daughter/ ward's last completed grade, end of year/last complete report card or a written statement of scholastic fitness from the school administration. Initial: ______HELMET WAIVER (for football participants) We acknowledge, AND WE understand the risks involved in my CHILD/WARD, my playing FOOTBALL, which is a collision sport; the NOCSAE committee has adopted the following warning to be read by, and signed by, both the parent/guardian and participant. DO NOT USE THIS HELMET TO BUTT, RAM OR SPEAR AN OPPOSING PLAYER, THIS IS IN VIOLATION OF FOOTBALL RULES AND CAN RESULT IN SEVERE HEAD, BRAIN OR NECK INJURY, PARALYSIS OR DEATH AND POSSIBLE INJURY TO YOUR OPPONENT, THERE IS A RISK THAT THESE INJURIES MAY ALSO OCCUR AS A RESULT OF AN ACCIDENTAL CONTACT WITHOUT INTENT TO BUTT, RAM OR SPEAR, NO HELMET CAN PREVENT ALL SUCH INJURIES. Parent/Guardian Initial: ______EQUIPMENT UNIFORM RESPONSIBILITY Player Initial: ______I assume full responsibility for any and all equipment/uniforms loaned to my child/ward and I agree to promptly return, upon request, the uniform and other equipment in as good condition as when received except for normal wear and tear. If I fail to adhere to this policy, I will be responsible for and promptly pay the replacement cost of such equipment. CODE OF CONDUCT Initial: ______The Ideology Of Youth Sports Including This Program Is To Promote Good Understanding And Fundamental Knowledge Of The Sport. It Is Also Critical That Good Sportsmanship Including The Ability To Always Conduct Oneself In An Appropriate Manner Of Positive Accord Both On And Off The Field. It Is Understood That Any Incident Considered Detrimental To The Pursuit Of This Ideology Will Not Be Tolerated. It Will Be Addressed In Accordance With The Statutes Of The Association, Conference, Current National Affiliation, State and Local Laws, And May Result In Dismissal From The Program And The Inability To Participate In Any Future Related Activities Of The Association. This Code Of Conduct Applies To All Involved With The Program Including But Not Limited To, The Football Players, Cheerleaders, Spirit Participants, Parents And Guardians. Initial: ______

PRINT Parents/Guardian Name: Parents/Guardian Signature: Date Signed:

NOTE: This form as with any and all forms used by your Association should be reviewed by your local counsel for compliance with any state or local statutes. This form should be kept on file for a minimum of 7 years. Page 2 of 2 Emergency Medical Treatment, Consent and Information The following information will be used in the event that a parent / legal guardian is not available. The purpose of this information is to provide a quick reference for medical personnel should the need arise. Please fill out this form completely. If a particular question is not applicable write "none", n/a, or other appropriate comment otherwise none will be assumed. If additional space is needed, please use the back of this form. All information disclosed here will be treated as confidential. It will be the responsibility of the parent/legal guardian to notify the participants coach and league/event officials if any information needs to be added, deleted, changed, or updated in any way. ATHLETE INFORMATION Athlete's Name: Nick Name: Phone: ( ) Address: City: State: Zip: PARENT OR GUARDIAN INFORMATION Father's Name: Address: City: State: Zip: Hm Phone: ( ) Daytime Phone: ( ) Email: Employer: PARENT OR GUARDIAN INFORMATION Mother's Name: Address: City: State: Zip: Hm Phone: ( ) Daytime Phone: ( ) Email: Employer: PARENT OR GUARDIAN INFORMATION Guardian's Name: Address: City: State: Zip: Hm Phone: ( ) Daytime Phone: ( ) Email: Employer: FAMILY MEDICAL INSURANCE Carrier: Group: Policy #: Group #: Policy Holder Name: Family Physician's Name: Dr's Address: City: State: Zip: Phone: ( ) Fax: ( ) Email: EMERGENCY MEDICAL INFORMATION Preferred Hospital(s): EMERGENCY CONTACT: Phone: ( ) Relationship: Please list any medical conditions (allergies, asthma, etc.) And medications being taken by the participant named above. Please list any other information you may deem relevant, and helpful to emergency medical personnel: (please note if no information is given and the words "none" or "n/a" is not filled in then, "none" will be assumed. Allergies: Medical Conditions: Other: *I Hereby my signature grant permission for my child/ward to participate in any and all, ______(Association name) and, American Youth Football, Inc / American Youth Cheer dba, program(s) sanctioned event(s), be they official or un official, including but not limited to, athletic, social and/or fundraising activities. I further hereby consent to any and all health care providers, authorize any first aid, emergency treatment, including but not limited to transportation to and from health care facilities and/or any medical professional to provide treatment, order injections, hospitalize, give anesthesia or perform surgery. I understand that this authorization is given prior to any need for medical care, but given to avoid unnecessary delay in emergency treatment which the attendant and/or medical professional may deem advisable in the exercise of best judgment. I presume a reasonable attempt was made to contact me.

*Print Parent/Legal Guardian Name *Signature Parent/Legal Guardian *Date The original Emergency Medical Treatment, Consent and Information form should travel with the coach and a copy should be kept at the administrative office of the sports organization. Due to privacy concerns, completed forms should be stored in a secure location with access restricted to those on a need to know basis for the purpose of medical care.

AMERICAN YOUTH FOOTBALL Medical Clearance Form ASSOCIATION NAME -

Medical Clearance Form - Must be dated after January 1st of the Current Season

I, as evidenced by my name and signature below, do certify that I am a State Licensed Medical Examiner in the state of and am qualified in determining that:

(Childs Name:) is physically fit and I have found no medical or observable conditions which would contra-indicate his/her from participating in youth flag football, tackle football, cheer, dance, step or athletic activities.

I am therefore clearing this individual for athletic participation.

Please Print - or - Use Office Stamp Here:

Signature: Print Name Clearly:

Date: / / ( Must be dated after January 1st, of the Current Season ) Office Address:

PLEASE NOTE: If this Medical Clearance is voided by injury, accident, or illness, it will be the responsibility of the Parent/Legal Guardian to notify the participants Coach and League Officials. It will also be the responsibility of the Parent / Legal Guardian to obtain WRITTEN permission from his/her State Licensed Medical Examiner to resume participation. A "Doctors Resume Participation Medical Clearance Form" is available from the league or you may have the doctor supply his/her own WRITTEN Clearance as long as it is on the doctor's official stationary and includes the following statement: "(Participants Name) is physically fit and I have found no medical or observable conditions which would contra-indicate him/her from participating in youth flag football, tackle football, cheer, dance, step or athletic activities. I am therefore clearing this individual for athletic participation. This statement must be supplied by the physician attending to the injury, accident, or illness.

This form can be modified or substituted ONLY to comply with local and/or state laws or due to medical practitioner regulations.

NOTE: This form as with any and all forms used by your Association should be reviewed by your local counsel for compliance with any state or local statutes. This form should be kept on file for a minimum of 7 years, longer in the event of an injury. Please confer with your local attorney for advice as to the appropriate maintenance and storage term for this and all such forms.

AMERICAN YOUTH FOOTBALL Waiver and Release of Liability - Minor

ASSOCIATION NAME - ______​ READ BEFORE SIGNING

IN CONSIDERATION OF______, my child/ward, being allowed to participate in the American Youth Football American Youth Cheer Regional/National Championships, and or the football and or cheer programs of ______, the Local Organization, which is a legally distinct and organization not operated or controlled by American Youth Football, despite its membership with American Youth Football, Inc. the undersigned acknowledges and agrees that:

The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) to my child from the activities involved in these programs are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and,

1. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child’s participation; and, 2. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and, 3. I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS American Youth Football, Inc.; its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 4. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. 5. I, the parent/guardian, assert that I have explained to my child/ward: the risks of the activity, his/her responsibilities for adhering to the rules and regulations, and that my child/ward understands this agreement.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Print Name of Parent/Guardian: ______

Parent/Guardian Signature: ______Date Signed: ______

UNDERSTANDING OF RISK I understand the seriousness of the risks involved in participating in this program, my personal responsibilities for adhering to rules and regulation, and accept them as a participant.

Print Name of Participant: ______

Participant’s Signature: ______Date Signed: ______

NOTE: This form as with any and all forms used by your Association should be reviewed by your local counsel for compliance with any ​ state or local statutes. This form should be kept on file for a minimum of 7 years, longer in the event of an injury. Please confer with your local attorney for advice as to the appropriate maintenance and storage term for this and all such forms. AMERICAN YOUTH FOOTBALL

Image Release – MINOR

ASSOCIATION NAME - ______

READ BEFORE SIGNING

In consideration of (insert child's name)______, my minor child/ward being allowed to participate in any way, in the American Youth Football, Inc. ("AYF") (dba American Youth Football and American Youth Cheer,) national championships and any other official AYF events and activities, the undersigned agrees that American Youth Football Inc., is hereby granted the unrestricted right and permission, free from approval or review, to copyright and/or use my child's/ward's likeness in all media now or hereafter known, including but not limited to, pictures and videos of my child which he/she may be included intact or in part for promotion or other commercial use.

Print Name of Parent/Guardian:

______

Parent/Guardian Signature: Date Signed:

______!

Mild Traumatic Brain Injury (MTBI) / Concussion Annual Statement and Acknowledgement Form

I, ______(athlete), have chosen to participate in an a sport where injuries may occur and I do understand that it is my responsibility to report all of my injuries and illnesses or suspected injuries and illnesses to the organization’s staff, including but not limited to: coaches, team physicians, and athletic training staff. I further understand and recognize that my health and safety is the most important thing and without disclosing all injuries and or illnesses, it can not be properly determined if you are in the physical condition necessary to participate. I understand that I must provide a full and accurate medical history including any symptoms, health complaints and any prior injuries and/or disabilities I have experienced before, during or after athletic activities.

By signing below, I acknowledge:

• My organization has provided me with specific educational materials including the CDC Concussion fact sheet (http://www.cdc.gov/concussion) on what a concussion is and has given me an opportunity to ask questions. • I ACKNOWLEDGE THAT I HAVE READ THE FACT SHEET on the CDC website for Parents and Players. • I have fully disclosed to the staff any prior medical conditions and will also disclose any future conditions. • There is a possibility that participation in my sport may result in a head injury and/or concussion. In rare cases, these concussions can cause permanent brain damage, and even death. • A concussion is a brain injury, which I am responsible for reporting to the team physician, athletic trainer, coach, parent volunteer, or official. • A concussion can affect my ability to perform everyday activities, and affect my reaction time, balance, sleep, and classroom performance. • Some of the symptoms of concussion may be noticed right away while other symptoms can show up hours or days after the injury. • If I suspect a teammate has a concussion, I am responsible for reporting the injury to the staff. • I will not return to play in a game or practice if I have received a blow to the head or body that results in concussion related symptoms. • I will not return to play in a game or practice until my symptoms have resolved AND I have written clearance to do so by a qualified health care professional. • Following concussion the brain needs time to heal and you are much more likely to have a repeat concussion or further damage if you return to play before your symptoms resolve.

Based on the incidence of concussion as published by the CDC football and cheer, among other sports, have been identified as high risk for concussion.

I represent and certify that I and my parent/guardian have read the entirety of this document and fully understand the contents, consequences and implications of signing this document and agree to be bound by this document.

Student Athlete:

Print Name: ______Signature: ______

Date: ______

Parent or legal guardian must print and sign name below and indicate date signed.

Print Name: ______Signature: ______

Date: ______AYF Code of Conduct - ______[print year here]

______(association name) will not tolerate verbal abuse of its volunteer coaches from any Fan, Parent or Spectator.

This is American Youth Football, not the pros. Fans, as well as the players and coaches, are expected to abide by a code of conduct at all American Youth Football Events. While 99% of the adults in the program will abide by this code without being told, this code is being published to protect the children and volunteers (which includes all coaches and board members) from the 1%.

FANS' CODE OF CONDUCT Fans will abide by a Code of Conduct which includes the provisions which follow. If any of these rules are broken, ______(association name) shall have the authority to impose a penalty. Fans shall: 1. Not criticize the players/cheerleaders or coaches in front of the other spectators in the stands, but reserve constructive criticism for later, in private. 2. Accept decisions of the game officials (including referees and coaches) on the field as being fair and called to the best ability of said officials. 3. Not criticize an opposing team, its players, coaches, or fans by word of mouth or by gesture. 4. Refrain from using physical or verbal abuse or profane language at any time at the game, practice field, or other AYF functions. 5. Abstain from being under the influence of or in possession of and/or drinking alcoholic beverages and the possession or use of any illegal substance on both the game and practice fields. 6. Not be allowed on the sidelines during a game. 7. Not interfere/interrupt the coaching staff before, during or after games or at practice. 8. Not express complaints about coaches in stands or to coaches in front of or around the children (i.e. right after a game or practice). VIOLATION Any parent or fan who violates the code of conduct risks the further participation of the child in the program. The procedure is as follows: 1. Any fan that violates the code of conduct or becomes a nuisance will be asked to leave by the head coach and can be suspended from all team activities. 2. If the fan fails to leave upon request, the child may be suspended from further participation in team activities by the head coach. 3. The head coach along with the executive board will decide if the duration of the suspension is to be longer than one to four weeks or if the child will be dropped from the program. That decision will depend on the attitude of the parents. 4. Any parent or fan who violates the code of conduct risks the future participation of his/her children in the program. Depending on the severity of the incident the board of directors may decide to ban future participation in the program for up to three years.

CONDUCT OF ALL PLAYERS - PARENTS All players are guaranteed 6 plays in each Jamboree, Regular Season or Playoff game. Everything beyond that must be earned in the opinion of the coaching staff whose decisions are final.

Athlete’s Code I will: emphasis the ideals of sportsmanship, ethical conduct and fair play. Show courtesy to my opponents and officials. Recognize athletic contests are serious educational endeavors. Give complete allegiance to my coaches who are the instructional authority for my team. Discourage fans, fellow players and parents from undercutting my coach’s authority. I will not: Use profanity or talk “trash” before, during or after any game. Use drugs, alcohol, or tobacco. Criticize my teammates. Act in any way that may incite spectators.

Parent’s Code I will: Support my child’s team/squad and teach the value of commitment to the team/squad - emphasis the ideals of sportsmanship, ethical conduct and fair play. Help my child and American Youth Football make athletic contests a positive educational experience. Show courtesy to opponents and officials. Direct constructive criticism of my child’s athletic program to the athletic director or association officials and work toward a positive result for all concerned. I will not: Criticize officials, direct abuse or profane language toward them, or otherwise subvert their authority. Undermine, in work or deed, the authority of the coach or administration. Intrude onto the field, stand on the sideline, or yell from the bleachers at or to the coaches, referees or administration.

1

AYF Code of Conduct - ______[print year here] - Signature Page*

I have read the AYF CODE OF CONDUCT and understand what is expected. By signing below, I agree to abide by all of the rules mentioned and any consequences if rules are broken:

Athlete’s Name (PRINT) Parents Name (PRINT)

Parents Signature Date

Association Name (PRINT) Division (i.e. FLAG, 6U, 7U, 8U, 9U, 10U, 11U, 12U, 13U, 14U)

*Please return this page with your package and keep the first page for your records.

2

A Fact Sheet for YOUTH SPORTS PARENTS

This sheet has information to help protect your children or teens from concussion or other serious brain injury.

What Is a Concussion? How Can I Spot a Possible Concussion? A concussion is a type of traumatic brain injury—or TBI— Children and teens who show or report one or more of the caused by a bump, blow, or jolt to the head or by a hit to the signs and symptoms listed below—or simply say they just body that causes the head and brain to move quickly back “don’t feel right” after a bump, blow, or jolt to the head or and forth. This fast movement can cause the brain to bounce body—may have a concussion or other serious brain injury. around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging the brain cells. Signs Observed by Parents • Appears dazed or stunned. How Can I Help Keep My Children or • Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent. Teens Safe? • Moves clumsily. Sports are a great way for children and teens to stay healthy • Answers questions slowly. and can help them do well in school. To help lower your • Loses consciousness (even briefly). children’s or teens’ chances of getting a concussion or other serious brain injury, you should: • Shows mood, behavior, or personality changes. • Help create a culture of safety for the team. • Can’t recall events prior to or after a hit or fall. ›› Work with their coach to teach ways to lower the Symptoms Reported by Children and Teens chances of getting a concussion. • Headache or “pressure” in head. ›› Emphasize the importance of reporting concussions and • Nausea or vomiting. taking time to recover from one. • Balance problems or dizziness, or double or blurry vision. ›› Ensure that they follow their coach’s rules for safety and the rules of the sport. • Bothered by light or noise. ›› Tell your children or teens that you expect them to • Feeling sluggish, hazy, foggy, or groggy. practice good sportsmanship at all times. • Confusion, or concentration or memory problems. • When appropriate for the sport or activity, teach your • Just not “feeling right,” or “feeling down.” children or teens that they must wear a helmet to lower the chances of the most serious types of brain or head injury. There is no “concussion-proof” helmet. Even with a helmet, it is important for children and teens to avoid hits to the head.

Talk with your children and teens about concussion. Tell them to report their concussion symptoms to you and their coach right away. Some children and teens think concussions aren’t serious or worry that if they report a concussion they will lose their position on the team or look weak. Remind them that it’s better to miss one game than the whole season.

GOOD TEAMMATES KNOW: IT’S BETTER TO MISS ONE GAME THAN THE WHOLE SEASON. Concussions affect each child and teen differently.While most children and teens with a concussion feel better within a couple of weeks, some will have symptoms for months or longer. Talk with your children’s or teens’ health care provider if their concussion symptoms do not go away or if they get worse after they return to their regular activities.

What Should I Do If My Child Plan ahead. or Teen Has a Possible Concussion? What do you want your child or As a parent, if you think your child or teen may have a teen to know about concussion? concussion, you should: 1. Remove your child or teen from play. 2. Keep your child or teen out of play the day of the injury. Your child or teen should be seen by a health care provider and only return to play with permission from What Are Some More Serious Danger a health care provider who is experienced in evaluating Signs to Look Out For? for concussion. In rare cases, a dangerous collection of blood (hematoma) 3. Ask your child’s or teen’s health care provider for written may form on the brain after a bump, blow, or jolt to the head instructions on helping your child or teen return to or body and can squeeze the brain against the skull. Call 9-1-1 school. You can give the instructions to your child’s or or take your child or teen to the emergency department right teen’s school nurse and teacher(s) and return-to-play away if, after a bump, blow, or jolt to the head or body, he or instructions to the coach and/or athletic trainer. she has one or more of these danger signs: Do not try to judge the severity of the injury yourself. Only • One pupil larger than the other. a health care provider should assess a child or teen for a • Drowsiness or inability to wake up. possible concussion. You may not know how serious the concussion is at first, and some symptoms may not show • A headache that gets worse and does not go away. up for hours or days. A child’s or teen’s return to school • Slurred speech, weakness, numbness, or decreased and sports should be a gradual process that is carefully coordination. managed and monitored by a health care provider. • Repeated vomiting or nausea, convulsions or seizures (shaking or twitching). • Unusual behavior, increased confusion, restlessness, or agitation. • Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously. Children and teens who continue to play while having concussion symptoms or who return to play too soon—while the brain is still healing— have a greater chance of getting another concussion. A repeat concussion that occurs You can also download the CDC HEADS UP while the brain is still healing from the first app to get concussion information at your injury can be very serious and can affect a child fingertips. Just scan the QR code pictured at or teen for a lifetime. It can even be fatal. left with your smartphone.

Revised 12/2015

To learn more, go to www.cdc.gov/HEADSUP